Surgical pad method for decubitus ulcer management

ABSTRACT

Method and surgical system for decubitus ulcer management, in which the surgical devices in the system each comprise a flexible, fluid-impervious bladder containing a gel or jelly formed as a colloidal system from water and a water-soluble resin which is a carboxy vinyl polymer of extremely high molecular weight and capable of displacement or flow within the bladder distributing the weight of the body of the user supported thereon. The mucilage or jelly has some form of elasticity and has yield value, both of which are controllable and variable and is capable of distributing pressure over an entire portion of the body resting on the bladder and avoids excessive pressure points thereon.

United-States Patent [191 Trenchard 1March 20, 1973 [54] SURGICAL PADMETHOD FOR DECUBITUS ULCER MANAGEMENT [75] Inventor: Sidney C.Trenchard, Westmont,

[73] Assignee: Margaret R. Trenchard, Westmont,

22 Filed: May 24, 1968 [21] Appl. No.: 731,864

[52] US. Cl. ..128/24 R, 128/68, 5/348 [51] Int. Cl. ..A6lh 1/00 [58]Field of Search ..l28/24, 68-, 149, 400, 153,

, [5 6] References Cited UNITED STATES PATENTS 6/1953 Filardo 128/594 UX2/1962 Nelson"; 3/1967 Spence .rl28ll49 UX Primary Examiner-Lawrence W.Trapp Attorney Edelson & Udell [57] ABSTRACT Method and surgical systemfor decubitus ulcer management, in which the surgical devices in thesystem each comprise a flexible, fluid-impervious bladder containing agel or jelly formed as a colloidal system from water and a water-solubleresin which is a carboxy vinyl polymer of extremely high molecularweight and capable of displacement or flow within the bladderdistributing the weight ofv the body of the user supported thereon. Themucilage or jelly has some form of elasticity and has yield value, bothof which are controllable and variable and is capable of distributingpressure over an entire portion of the body resting on the bladder andavoids excessive pressure points thereon.

9 Claims, 4 Drawing Figures surrounding tissue is not properly nourishedby blood and local necrosis occurs. Patients confined to a con- 7ventional bed are subject to the formation of such ulcers. Onconventional mattresses steps taken to relieve pressure on decubitusulcer sites will only transfer pressure to other sites where additionaldecubitus ulcers could and will form. The patients are moved andmassaged to attempt to relieve the formation of such ulcers.

Decubitus ulcer management has presented a considerable problem andattempts have been made to preclude the formation of such ulcers. Thus,;patients have been made to float on water-filled bladders which willmake some patients seasick. vThe bladder will tend to mold, withinsubstantially very restricted limits, to the patients body therebymaking more body surface available for weight-bearing. Use has been madeof pads made of self-contained, stable, chemically inert gel" coveredwith a thin elastic membrane which acts to protect the gel but does notconstrict or inhibit the properties of the gel which itself hasrestricted deformation capabilities. Because of their compressionlimitations, i.e., water is not compressible and the self-contained gelhas limited internal displacement, these known devices are not aseffective as they might be. They are often too small for large personsand too expensive.

It is a principal object of the present invention to provide a novelmethod and system for supporting the human body for prolonged periods oftime without excessive external pressure on localized areas of tissueover rigid bony structures of the body.

In accordance with the invention a flexible, jelly-containing bladdereither in the form of a pad, for a seat, a pillow ora mattress isprovided. A weight-bearing colloidal solution, such as a weight-bearingjelly, is contained in the bladder and has a controllable viscosity,greater than that of water. The jelly has some form elasticity and iscapable of accurately conforming to a surface of the body supportedthereon effectively distributing the weight of the body of the user sothat pressure is distributed over the entire surface of the portion ofthe body resting on the bladder to avoid excessive pressure points. v

A feature of the surgical devices in accordance with the invention isthat the jelly fill of the bladder will displace internally and has flowcharacteristics such that nurses can readily place their hands under thebody of a patient on a mattress according to the invention for rotatingormoving him.

1 Other features and advantages of the surgical pad, pillow and mattressand apparatus and system in accordance with the present invention willbe better understood as described in the following specification andappended claims, in conjunction with the following drawings in which:

FIG. 1, is a perspective view of a surgical pad made according to theprinciples of the invention;

FIG. 2, is a perspective view of the pad in FIG. 1 in a filledcondition;

FIG. 3, is an elevation view of a patient on a wheelchair illustratingthe use of the pad in FIGS. 1 and 7 FIG. 4, is a perspective view of ahospital bed provided with a mattress made according to the invention.

A surgical pad made according to the invention is illustrated in FIGS.1-3 inclusive and comprises a bladder 11 made of a fluid imperviousmaterial, for example a virgin polyvinyl chloride so that it has askinlike texture. The bladder has its peripheral edges heatsealed sothat it can act as a fluid-tight jelly-filled container for supporting apatient thereon as hereinafter described. The bladder 11 is constructedwith a watersoluble bag 13 disposed therein containing a chemicalcompound in powder form, for forming a deformable colloidalsolutionwithin the bladder 11 by the addition of water through a closable plug14. The body of the bladder is provided with an air valve 15 for ventingof the bladder when filling with water in making the colloidal systemand to allow testing of the bladder by application of air pressure andsubmersion in water, with the plug 14 in place, before filling thereof.

When the pad '11 is to be used a volume of water, suitable to the volumeof chemical compound in the bag 13 is applied through the plug 14 andthe colloidal system will be formed and expand or swell the bladder 11to form a jelly-filled pad as illustrated in FIG. 2. The bladder isprovided with ties 17, 18 heat-sealed along the edges of the bladder fortieing the pad to a back 20 of a wheelchair 21 so that a patient cancomfortably sit thereon as illustrated in FIG. 3.

For purposes of illustrating the invention, the bladder 111 is assumedto be a 22 inch X 22 inch square in which is contained the bag 13containing three ounces of the powdered chemical compound Carbopol 960which is the ammonium salt of Carbopol 934 or carboxypolymethylene. Thechemical compound is a water-soluble resin. The resin is a carboxy vinylpolymer of extremely high molecular weight made by B. F. GoodrichCompany and described in the company's Service Bulletin GC-36 Revisedand Bulletin GC-42. When water is addedto the bladder 11, the bag 13 isdissolved and the water and chemical create a homogeneous jelly. As anexample, it has been found that gel contents with a viscosity ofapproximately 58,000 cps, (Brookfield at 20 rpm) can be formed inbladder 13 by the three ounces of the chemical compound and theapplication of 1% gallons of water. This jelly or paste has acontrollable form elasticity and yield value so that the surface of theportion of the body of a patient resting on the pad has the pressuredistributed over its entire area and excessive pressure points thereonare avoided, thereby avoiding the major cause of pressure sores. Thejelly distributes the weight of the body of the patient to effect thepressure distribution so that the patient is without possibility offormation of pressure sores or decubitus ulcers on his buttocks becauseof the pattern of weight distribution over the patient's buttocks.

The invention is equally applicable to the construction of a head pillow27 and a mattress 29 constructed in the manner above described as to theseat pad. The mattress is constructed with four corner ties 30 forsecuring the four comers thereof to posts 32 of a bed 34 as illustratedin FIG. 4. The jelly-filled pillow and/or mattress and the padheretofore described may have the viscosity of the jelly uniform orvaried by controlling the amount of water applied to the powderedchemical or by addition of water in local areas as describedhereinafter. The bladders from which the various devices are made canhave the jelly within different portions or volumes of the bladder vary.Thus, some of the contents can be withdrawn or added and more wateradded to lower the viscosity in certain portions of the device or someof the resin can be added to increase viscosity, and the devices, forexample the mattress, can be compartmented so that the compartmentsthereof can have the different viscosities of the jelly therein. Thechange in viscosity will change the form elasticity and yield value.Yield value is defined as an initial resistance to flow under appliedstress. The jelly offers low'resistance to manipulation. A practicalsignificance of yield value is that it prevents phase separation, i.e.breaking of solids settling from the dispersion.

In one mattress constructed having beneficial results in the treatmentof decubitus ulcers it was found that an average viscosity of 18,000 cpswas recommendable. In that case the mattress was made as 40 inches X 40inches square pads in which 8% ounces of the chemical powder werecontainedin a plastic water soluble bag and about 17 gallons of waterwere added thereto to obtain the desired viscosity. With suchconstructions, two-pads can be used as a mattress or one pad used on theupper or lower part of the body of the patent.

Moreover, the mattresses can be made with ribs sealed every six inchesacross the mattress top half with separate filling plugs, not shown,between each rib and thus, the bed may be raised without a correspondingshift of contents to the lower part of the mattress.

It has been found that paraplegics and their physicians usually prefer alow viscosity jelly in the surgical devices used by them so that greatermovement is transmitted throughout the contents. Thus, when the patientsarms are moved it creates internal movement through the contents of themattress and this applies a massaging effect on the patient which alsotends to cut down on the need for regular turning. Furthermore, the lowviscosity makes it possible for a nurse to insert her hands under thepatients body to move him or roll him over without bruising the patientsskin.

The use of the pads and mattresses containing the gelatinous contentshas indicated alleviation of decubitus ulcers and curing thereof due tothe avoidance of pressure spots. If the surgical devices are used fromthe beginning of confinement in bed or in a wheelchair decubitus ulcerswill not be formed. Furthermore, it has been found that the surgicaldevices are easily washed and cleaned with a detergent, alcohol orsuitable antiseptic so that they can readily be kept sanitary.

It is known that in Newtonian systems flow is directly proportional toapplied stress. Pseudoplastic solutions flow 'morereadily as shearstress is increased. The water-soluble resin solution is of this type.Solutions exhibiting plastic flow do not flow until the applied shearstress exceeds a certain minimum value. This minimum is known as yieldvalue. The chemical powder, heretofore described, forms a plastic flowsolution with a yield value determined by the measure of viscosity ofthe solution with a Brookfield RVT Viscosimeter (Brookfield; 20 rpm).Thus, the thickness of the formulation is variable and controllable. Thejellyis non-toxic, essentially inert in contact with the body and stableto bacterial attack.

The chemical heretofore described is preferred for making the gelatinouscontents because it is a salt and does not require neutralizing.Moreover, if lumps are formed when water is applied, the lumps ofsoluble ammonium salt will solvate and swell. After the lumps haveswollen a slight working of the material as the mattresses is readiedfor use on a chair or bed will produce a smooth homogeneous gel.

The makers of Carbopol water-soluble resin make other usablewater-soluble resins such as Carbopol resin 961" which is the ammoniumsalt of Carbopol resin 941. Water-soluble acid Carbopol resins 934, 940,941 have the same properties of Carbopol resins 960 and 961 whenneutralized to the identical pH, of the salt resins, with ammoniumhydroxide. Viscosity and neutralization data of Carbopol water-solubleresins formulations made with water is provided by the service bulletinsof the manufacturer heretofore mentioned so that the recipe for thedesired thickness of the formulation can be readily determined.

While preferred embodiments of the invention have been shown anddescribed it would be understood that many modifications and changes canbe made within the true spirit and scope of the invention.

What I claim and desire to be secured by Letters Patent is: i

l. A surgical device for supporting at least a part of the body of auser comprising, a liquid-impervious flexible bladder having a selectedconfiguration, a mucilage or jelly of selectively adjustable viscositycontained in and at least partially filling said bladder, said mucilagehaving a viscosity greater than water and being capable of viscousflowdisplacement within said bladder to thereby enable the latter to conformto and support the part of the body of the user supported on saidbladder and being effective to cause pressure distribution over theentire portion of the body of the user resting on said bladder, wherebyexcessive pressure points on the supported portion of the body areavoided.

2. Surgical device for supporting at least a part of the body of theuser according to claim 1, in which said jelly has a viscosity in therange between about 18,000 centipoise and 58,000 centipoise.

3. Surgical device for supporting at least a part of the body of theuser according to claim 1, in which said mucila'ge comprises acarboxyvinyl polymer of extremely high molecular weight.

4. Surgical device for supporting at least a part of the body of theuser according to claim 1, in which said mucilage comprises water and awater-soluble dry resm.

5. Surgical device for supporting at least a part of the body of theuser according to claim-4, in which said resin comprises a carboxy vinylpolymer of extremely high molecular weight.

6. A surgical device according to claim 1 wherein said mucilagecomprises a solid constituent dispersed in and physically bonded to aliquid constituent, the physical bond being breakable by applied shearstress to permit plastic flow and being then re-established.

7. A surgical device according to claim 6 wherein the viscosity of saidmucilage is variable as desired and precisely controllable bycontrolling the ratio of the solid to the liquid constituent.

8. A method of supporting a human body comprising, mixing water and apolymer of extremely high molecular weight in a confined volume to forma deformable colloidal system characterized by plastic flow having aviscosity greater than the viscosity of water and having form elasticityand a selected yield value, and continuing confinement of said colloidalsystem while supporting a human body on said confined volume, wherebypressure is distributed over an entire portion of the human body restingthereon and excessive pressure points on said portion of the body areavoided.

9. A surgical device for supporting at least a part of the body of auser comprising, a liquid-impervious flexible bladder having a selectedconfiguration, a predetermined quantity of a'dry resin contained in saidbladder, said resin when having a liquid added thereto forming amucilage or jelly of selectively adjustable viscosity which at leastpartially fills said bladder, said mucilage when formed having aviscosity greater than water and being capable of viscous flowdisplacement within said bladder to thereby enable the latter to conformto and support the part of the body of the user supported on saidbladder and being effective to cause pressure distribution over theentire portion of the body of the user resting on saidwbladder, wherebyexcessive pressure points on the supported portion of the body areavoided.

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2. Surgical device for supporting at least a part of the body of theuser according to claim 1, in which said jelly has a viscosity in therange between about 18,000 centipoise and 58,000 centipoise.
 3. Surgicaldevice for supporting at least a part of the body of the user accordingto claim 1, in which said mucilage comprises a carboxy vinyl polymer ofextremely high molecular weight.
 4. Surgical device for supporting atleast a part of the body of the user according to claim 1, in which saidmucilage comprises water and a water-soluble dry resin.
 5. Surgicaldevice for supporting at least a part of the body of the user accordingto claim 4, in which said resin comprises a carboxy vinyl polymer ofextremely high molecular weight.
 6. A surgical device according to claim1 wherein said mucilage comprises a solid constituent dispersed in andphysically bonded to a liquid constituent, the physical bond beingbreakable by applied shear stress to permit plastic flow and being thenre-established.
 7. A surgical device according to claim 6 wherein theviscosity of said mucilage is variable as desired and preciselycontrollable by controlling the ratio of the solid to the liquidconstituent.
 8. A method of supporting a human body comprising, mixingwater and a polymer of extremely high molecular weight in a confinedvolume to form a deformable colloidal system characterized by plasticflow having a viscosity greater than the viscosity of water and havingform elasticity and a selected yield value, and continuing confinementof said colloidal system while supporting a human body on said confinedvolume, whereby pressure is distributed over an entire portion of thehuman body resting thereon and excessive pressure points on said portionof the body are avoided.
 9. A surgical device for supporting at least apart of the body of a user comprising, a liquid-impervious flexiblebladder having a selected configuration, a predetermined quantity of adry resin contained in said bladder, said resin when having a liquidadded thereto forming a mucilage or jelly of selectively adjustableviscosity which at least partially fills said bladder, said mucilagewhen formed having a viscosity greater than water and being capable ofviscous flow displacement within said bladder to thereby enable thelatter to conform to and support the part of the body of the usersupported on said bladder and being effective to cause pressuredistribution over the entire portion of the body of the user resting onsaid bladder, whereby excessive pressure points on the supported portionof the body are avoided.